UPDATED! Prior Authorization for SUD Residential & Inpatient Services is Being Reinstated

The Cabinet for Health and Family Services announced April 29th that they are reinstating prior authorizations requirements for Substance Use Disorder (SUD) Residential and Inpatient Services effective July 1st, 2022. The full guidance letter has been UPDATED since last week; you can read the full letter from the Cabinet here. If you are unfamiliar with Medicaid provider types, here is the full list for your reference.

Under the current KY HEALTH SUD 1115 Demonstration authority, the state is required to ensure there are utilization management approaches implemented to ensure that there is an independent process for reviewing placement in residential treatment settings, and interventions are appropriate for the diagnosis and level of care.

The KY State Plan requires individuals must be assessed and meet the Dimensional Admission criteria for approval of residential level of care placement in accordance with the most current edition of The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions.

Beginning July 1st, 2022, the prior authorization requirements for SUD residential and inpatient treatment services, including ASAM Levels 3.1, 3.5, 3.7 and 4.0 will be reinstated.

Individuals should contact Angie Parker at the KY Department for Medicaid Services with any questions by emailing AngelaW.Parker@ky.gov.